Provider Demographics
NPI:1740738095
Name:PONCE DE LEON SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PONCE DE LEON SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-SETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-343-2672
Mailing Address - Street 1:552 PONCE DE LEON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1806
Mailing Address - Country:US
Mailing Address - Phone:404-343-2672
Mailing Address - Fax:
Practice Address - Street 1:552 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1806
Practice Address - Country:US
Practice Address - Phone:404-343-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical